Tuesday, February 24, 2009

Back at the hospital


Lautoka Hospital from the back


After taking a few months off from observations at the hospital, I have managed to weasel my way back in. This time in obstetrics and gynecology, where I have observed three natural births in the first day. I'm becoming more and more fascinated by the medical field- particularly the practical/clinical portions.

The medical students have changed since last year. There is a new batch of sixth year students, who Im just starting to meet. They will be doing their attachment at Lautoka Hospital for the next year before, most of them, return back to their respective countries.

Fiji School of Medicine is the only internationally recognized medical school in the South Pacific. This means that each incoming class will include students from all over the pacific like; Samoa, Tonga, Solomon Islands, etc. Many of them are sponsored by bond programs provided by international organizations. They literally get paid to become doctors for their own countries. That's pretty neat, if you ask me.

Chompers

The fluoride varnish project is starting to get off the ground. We have found out that we can expand the number of kids that we had originally allotted and cast out a larger net. We are now looking at a total of three schools, which will drastically improve the legitimacy of the research we are able to get out of the project. The research will be crucial to presenting the idea of switching over from gel to varnish, to the Ministry of Health.

I have been working with the dental outreach team who is very excited about changing over to varnish. They too think it will be much more effective. The gel they are using now contains only 0.4% fluoride, less than most fluoridated toothpastes.

I was invited to see the how they are currently applying the fluoride gel. Below are the photos from the visit.



Waiting for recess to finish

Kids lining up

Getting ready to receive fluoride on their toothbrushes

Kids who didn't bring toothbrushes applied fluoride with their forefingers

Boxes and boxes, cartons and cartons.

I was sure that the couple of days it took to organize the hand over ceremony for two 40ft containers worth of medical equipment would be the hardest task. I realized my error when I stepped foot on the yard where the containers stood staring back at me.

The containers were completely full. There were about six to ten men working at any given time. One would drive the forklift while the others would carry the boxes two or three at a time. I could only carry one or two, depending on the size.

The first day was the most difficult and the hottest. It was a Saturday afternoon and the Rugby 7s Tournament in Wellington, NZ, was going on. If I haven't mentioned it before, rugby is practiced and watched fanatically here in Fiji. Everyone follows the game, and Fiji has been the world cup champions for the last two, and people are hoping that this year will make it three. Anyway, people wanted to watch, and I didn't want to be the one who stopped them. Needless to say the day moved slowly.

Despite the already slow moving day, we were forced to restart a number of times due to logistical errors. Terminology the first time, 'cartons' vs 'boxes'. Then it was that the numbers didn't add up- the actual number sent differed from the inventory checklist. So by the quarter finals we threw in the towel and decided to start again the following afternoon. A few of us went back to J's house to drink beer and cross our fingers for a Fiji victory in the tournament.

(Oh wait, before I continue on about separating boxes, I must tell you how amusing the Wellington 7s extravaganza is. Okay so, every team that's any team has at least one Fijian on it- New Zealand has 4, Australia 3, England 1, etc. So here we are routing for Fiji, when in reality it doesn't really matter because in a way, Fiji wins anyway. England ended up winning, and even though the final points were scored by Domodomo - a fijian player- there was little acknowledgment from the team. But, when Domodomo tried to defend the Pomies from the Fiji players during the match between the two countries, all the Fijians were pissed and tried to fight Domodomo. Must be hard to be him... traitor to his country, outsider to his team, isa.)

Sunday afternoon, a day of rest for most, was spent at the warehouse sorting through boxes. Everyone showing their flexed muscles was ready to work. I don't know if it was because people were still upset about the results from the tournament the previous night, but everyone worked without a break from noon to 8pm.

Finally, its all finished...

http://www.fijitimes.com.fj/story.aspx?ref=archive&id=114769


starting to take out the boxes of the first container to be sorted

sans the forklift- see, only one box

The first attempt when we thought 'cartons' meant entire 'boxes', when in reality, there were six cartons to a single box. oi lei!

Labeling the boxes for distribution, only to later find out that our second attempt would also be wrong. At this point we spent hours trying to figure out the difference in the numbers we actually had been sent compared to what was stated on the inventory lists.

Wednesday, February 4, 2009

2009 projects

People are still asking what my main projects are, so I will dedicate this entry to outlining what I’ve been working on in the last few weeks…

First, I should mention that the box of bras have found a home in a maternity clinic in Ra… if you’re confused by this reference go back to the entry titled ‘An uplifting project’.

The major project for this week has been allocating $2 Million worth of medical equipment sent through donors from Rotary Clubs in Australia. There are currently two full containers filled with cartons of syringes and other medical necessities. The past week has been spent finding proper locations for this equipment and dealing with logistics to get it there. I am the liaison between Rotary and Ministry of Health- Western Division. Basically what has previously take over two months, I made happen in three days. I felt useful.

I will be sorting through the medical equipment all day Saturday with a Rotarian and few workers from a shipping company who will be doing most of the heavy lifting. The allocations have been identified for eight different sub-divisional hospitals and health centers in the west. Once sorted, the trucks will begin distributing the material on Monday.

As you may recall, a JICA volunteer and I created a program we called ‘Condoms and Clubs’ in Suva. This program was developed as a method of providing additional late night access points for condoms by promoting and providing them in nightclubs throughout the city. Initially I had wanted to hold the program in Lautoka, but was presented with the option of pre-testing it in Suva first. After Suva, I came back to my post in Lautoka ready to start all over.

Having seen the program through in Suva, it was easy to identify the adjustments needed. My major concern turned to sustainability. I constantly hear people talk about volunteer projects from the past, and few still exist. My thought process was this-- So how do I make mine sustainable? Well, first find a sustainable group, right? Okay. But how about one that’s interested in reproductive health issues… Eureka! Sex workers!

Sex workers in the west currently have an advocacy group called The Pacific Rainbow Project that meets every Wednesday. In the past six months I’ve given them presentations and workshops on HIV and STIs, gone to the occasional meeting, and participated in all of their fund raising programs. So I decide to call the coordinator of the program and ask if I could come in and give another presentation, this time about the ‘Condoms and Clubs’ campaign. He was delighted and thought it would be a swell idea.

I came in with my guns loaded- lots of pictures from the Suva program. Every Fiji national I’ve ever met has LOVED photos. I knew it would work. I showed the photos- many of them posted on the entry titled ‘Success’. After the slide show finished, I asked if they were interested in participating in the planning and development of the Lautoka project.

After deliberating among themselves, they decided it would be fun. But, they were concerned about volunteering because the distribution times would coincide with peek times for their work. After explaining that they could help develop the project without being the volunteers, they still decided it would be an enjoyable activity. YAY.

That was last week’s meeting and this week we drew up a timeline for the project. We’re making some progress. Honestly though, who knows more about night life than sex workers? They were throwing around ideas that I would have never thought of, places I’d never heard of. It was great. Don’t get me wrong, if it doesn’t get more exciting in the next meeting the flame will surly fade. So if anyone has ideas to keep things exciting, please send your comments.

The other major project I’m working on is a Fluoride varnish program. Basically 88% of children in Fiji suffer from tooth decay- and from what I’ve seen it’s mostly moderate to severe. There is a public health initiative through the Ministry of Health that provides children with fluoride- in gel form. It’s hard to monitor and they don’t reach everyone, but is still effective. So, why are we pushing a fluoride varnish? Well, a volunteer in Fiji who was pre-dental decided she would try to implement the first nation-wide fluoride varnish program (not just the first in Fiji, but the first in the world). The program was/is a great idea because fluoride varnish is stronger and more effective for people who don’t regularly visit a dentist. It’s also quicker and less dangerous.

Anyway, that volunteer finished her service but didn’t finish the program- even though she extended for an additional year. She passed on the project to another volunteer who was basically left with everything- the proposal, the money, etc. Unfortunately, the major donor (Colgate) fell through and the project needed to be scaled down drastically.

But, all is not lost. With the research from this program a nation-wide fluoride varnish program may still be put into place in the future. Who knows?

Now that you know the background, my involvement is basically to set everything up in the western division. Today is the meeting to discuss statistics from all of the primary schools the outreach team went to in the last year. From this we will decide which 2 schools to implement the varnish program at (and the other schools will be scheduled for the regular fluoride gel application). After a decision is made we will start with the preparations. Carla (the volunteer who has taken the project over) will come up from Suva for a meeting I have set up with the dental department from Lautoka hospital on February 17, 2009. Soon after, (as soon as the materials are brought in- without forgetting to factor in some Fiji time with that) the fluoride varnish program can start after the three year battle.

So that’s that. That is what I’ve been working on.

A lot has changed since the last entry... people are beginning to get over the holiday hangover.